Fat Grafting

Chapter 46. Fat Grafting

Kenneth B. Hughes, MD

INDICATIONS

Structural fat grafting is used to enhance contour in virtually any area amenable to grafting, and the indications are continually expanding. The first and most common indication for structural fat grafting is breast reconstruction defect. With the increased popularity of fillers for facial augmentation, fat grafting for facial augmentation has been a result of the plentiful nature of filler material available and decreased cost, particularly for larger volume needs or as an adjunctive measure in facelifts.

Less common indications include buttock augmentation, breast augmentation, and hand rejuvenation. Fat grafting has also received attention for volume restoration in acquired or congenital conditions such as HIV lipodystrophy, Parry-Romberg syndrome, and craniofacial microsomia.

ANESTHESIA

As with many liposuction procedures, the choice for anesthesia is largely dictated by amount of tissue to be harvested, the number of harvest sites, the number of areas to be augmented, and the volume to be instilled. Some minor revisions can be performed under local anesthesia alone. Tumescent anesthesia may allow the donor site surface area to be increased. However, there is a theoretical concern of disruption of fatty tissue and concomitant decreased survival with these methods.

In addition, the manner of liposuction and technique utilized should be considered. Removal through smaller volume Luer-Lok syringes is theoretically less traumatic to the fat and less painful to the patient as compared to fat harvest through traditional suction cannulae with much greater suction pressures.

DETAILS OF PROCEDURE

Typical donor sites for fat grafting include the abdomen and thighs. They are convenient access points in the supine position, as breast reconstruction defects and facial augmentation are the most common indications. This also permits a 2-team approach in which one can harvest, while the other can inject. However, almost any site with readily accessible fat will serve as an adequate donor site.

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